You can find a pharmacy on almost every street in Ulaanbaatar. While the accessibility to pharmacies in Mongolia is relatively good, their sales and storage of products are not supervised as much as they ought to be. According to the Ulaanbaatar Health Office, there are 990 pharmacies operating in the capital and only 189 of them are considered first-rate, or up to standard, while the rest are second-rate. Especially around ger areas and the outskirts of the city, people are able to buy any drug without a prescription from a doctor. In some pharmacies, the pharmacist behind the counter recommends medicines based on their experience of which medicines people typically buy for a particular ailment. Most pharmacists have no formal knowledge or certification of pharmacology. The National Council of Standardization revised the General Requirement for Pharmacy (MNS 5260:2015) on November 26, 2015, based on recommendations by the World Health Organization and amendments to the National Medicines Policy and Law of Medicines. The following recommendations were reflected in the revised General Requirement for Pharmacy:

• To use this standard as criteria for accreditation process
• Add a definition for clinical pharmacy services
• The director of the central pharmacy in a province must live in the respective vicinity
• A hospital pharmacy must be managed by a pharmacologist specialized in pharmacy management and clinical pharmacy
• A pharmacy must have separate sections for prescription drugs and over-the-counter drugs
• Corridors and stairs connected to a pharmacy must be wider than one meter and shelves and other furniture must not be placed in this area
• Pharmacies must submit operations report

Unfortunately, most of these criteria are disregarded and not implemented. Large pharmacies such as Monos, Asia Farm, Tavin Us, Mongol Em Impex Concern, and Khurmen are the only ones close to the standard. However, they’re lacking in some areas as well. For example, the majority of their branches located near ger areas do not meet requirements set for pharmacy buildings. According to experts, some of their pharmacists negotiate with customers and sell medicine that has the same effect as a prescribed drug. Many pharmacies are located on the first floor of an apartment building within a small area. There have been reported instances where a pharmacist couldn’t read a doctor’s prescription and gave a wrong drug. Experts noted that operating with a vague “pharmacy” label instead of a specific label violates the law. It wouldn’t be an exaggeration to say that nowadays, pharmacies operate purely for profit, not for the public health or well-being.

MONGOLIAN PHARMACIES FAIL TO MEET STANDARDS

Specialist from the Ulaanbaatar Health Office D.Boldbaatar, who manages issues related to the quality, supply and supervision of medicine, medicinal equipment and pharmacies, gave a brief interview about pharmacies in Mongolia. The Ulaanbaatar Health Office issues permits required for operating a pharmacy. How many permits has the office granted since January? At present, 990 pharmacies are operating in Ulaanbaatar with permits provided by our office. Out of these pharmacies, 189 are first-rate and 801 are second-rate. Since January, we have given permits to 97 more pharmacies. Permits are granted after reviewing the location, its demand, and whether it meets standards on pharmacies. There’s a standard which specifies that there needs to be a pharmacy for every 5,000 people and that pharmacies have to be at least 500 meters apart from one another. Is this standard being enforced? The Standard on Pharmacy was renewed in 2015. The standard about having a pharmacy for every 5,000 people and their distance being at least 500 meters isn’t being followed right now because the Authority for Fair Competition and Consumer Protection complained to have the article removed as it violates two to three articles in the Law on Conflicts and gives an advantage to an organization. In other words, people can run a pharmacy as long as they have a standard building, is equipped with necessary equipment and devices, and managed by a professional. However, we’re more supportive of those trying to open a pharmacy in ger areas located in the outskirts of the city. Pharmacies provide services like ordinary stores. Antibiotics are sold as if they’re candy. Are you doing anything to supervise the sales of pharmacies? There’s no problem if pharmacies are following the General Requirement for Pharmacy (MNS 5260:2015). It sets specific standards for the quality of medical equipment and services of pharmacies. For example, a second-rate pharmacy must be at least 24 square meters in size and have one or two pharmacists and a pharmacologist, according to the General Requirement for Pharmacy.

PRICING AND STORAGE ISSUES

 Have you ever wondered why two to three pharmacies on the same street sell the same product for different prices? Let’s take Monos Pharmacy for example. The price of Vitagrip tea against cold differs depending on the location of each branch of Monos Pharmacy. They’re sold for a slightly higher price near apartment complexes and for lower prices near ger areas. Even vitamin C supplements are sold for different prices at two pharmacies located right across the street from one another. The first pharmacy charged 750 MNT per pack of vitamin C, while the second charged 1,000 MNT. When enquired about the difference in price, the pharmacists at the counter explained that it was related to their manufacture date. Moreover, the same supplements are sold for almost double the price at pharmacies inside hospitals. This is the reality for ordinary vitamin C supplements, which we can buy any day. Based on this, the government clearly needs to have a policy for ensuring fair prices of medications in the future. Some pharmacies are said to be cheaper than others mainly because the medication has been kept for a longer time, or are nearing the expiration date. When pharmacies aren’t able to meet the basic building requirements, it’s difficult to convince ourselves that they properly follow standards on the storage of medications and other products. Most people know that drugs can lose some of their potency over time, but what is less understood is that the substances that remain as drugs break down can actually be harmful. Hence, always remember to check the labels, especially expiration dates, on medications. Doctors advised that when drugs aren’t achieving the expected results, patients should talk to their healthcare providers about the possibility of having a problem with the drug itself, not their response to it. People should be especially careful with compounded products, like when a parent crushes a tablet and adds water to make it easy for children to swallow, as they could have become less effective than in their original form. Medications are special products that require special storage, but pharmacies don’t seem to realize it or are simply unable to ensure proper storage of medications. These problems need to be addressed and resolved before a major incident occurs. Pharmacies might be private companies but their operations need to be regulated and supervised so that medications are safer and people don’t have to worry about the quality of medications when buying them from a nearby pharmacy. These issues with pharmacies shouldn’t be taken lightly as they could have tremendous health repercussion.                                                                                                   This article was originally published in Mongolian in Undesnii Shuudan